Oncology & Hematology Coding Alert

Look for specific codes for biologicals, interleukins, and other chemotherapy options.

The therapy for malignant melanoma is complex given the chemotherapeutic agents your ongologist may use. Added to these are the interleukins and antibodies that can puzzle even seasoned coders. Here is a quick overview of the chemotherapy options and the corresponding codes.

Also, be sure to check the ICD-10-CM codes that you can submit for a malignant melanoma claim.

1. Learn With This Interleukin Example

First of all, you should look at a common scenario. If a patient has malignant melanomas, your oncologist may use interleukins. Before you lose focus, try to figure out a definitive code for this therapy.

Example: If your physician administers aldesleukin, you turn to code J9015 (Injection, aldesleukin, per single use vial).

What is aldesleukin? Aldesleukin (Proleukin^®) is a form of recombinant interleukin-2 that is produced by using the recombinant DNA technology using a strain of Escherichia coli bacterium.

Bill for every vial: Aldesleukin is available in a single-use vial. One whole vial of aldesleukin contains 18 million units. You have no other choice but to bill for the whole vial, even if only part of it was used.

Wastage: Document the dosage delivered, the total amount contained in the single-use vial, and the amount of drug that was wasted.

Example: Suppose your physician administered 4 million units three times a week to a patient with melanoma. In this case, you should bill the entire vial three times a week.

Administration code: Aldesleukin is administered by a 15- minute intravenous infusion every 8 hours. You should submit code 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug) for the IV push of aldesleukin.

List Other Common Agents

Here are some examples of some other biological/chemotherapy options your physician may use in malignant melanoma:

• J9214, Injection, interferon, alfa-2b, recombinant, 1 million units
• J9228, Injection, ipilimumab, 1 mg

2. Check the Recent Advances in Chemotherapy

You should be aware of chemotherapy advances in coding. Effective Jan 1, 2016 you have a new code J9271 (Injection, pembrolizumab, 1 mg) for pembrolizumab (Keytruda^®).

What is pembrolizumab? Pembrolizumab is a programmed death receptor-1 (PD-1)-blocking monoclonal antibody indicated for the treatment of patients with unresectable or metastatic melanoma. It prevents the growth and spread of cancer cells.

Available strengths and dosage: Pembrolizumab is available as

• 50 mg lyophilized powder in single-use vial for reconstitution
• 100 mg/4 mL (25 mg/mL) solution in a single-use vial

Dosage: The recommended dose for pembrolizumab is 2 mg/kg. Pembrolizumab is administered as an intravenous infusion over 30 minutes every 3 weeks.

The Center for Medicare and Medicaid Services (CMS) introduced this permanent J-Code for Keytruda^® effective January 1, 2016. This means for dates of service on or after January 1, 2016, you would submit claims with code J9271. You submit one unit of code J9271 for every 1 mg of pembrolizumab injected.

Administration code: The injection of pembrolizumab is typically administered over 30 minutes, hence you submit code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for this service.

3. Not All Options Have a Code

With advances in the management of malignant melanoma, a number of biologicals are increasingly being used.

Example: Common biologicals used in malignant melanoma include Trametinib, cobemitinib, and vemurafinib. These agents do not have a dedicated J code. You submit code C9399 (Unclassified drugs or biologicals).

Note: For codes without a specific HCPCS code, an unclassified oncology drug, refer to the box on page XX.

4. Diagnosis Coding for Malignant Melanoma

When you’re reporting chemotherapy, you have to be vigilant with your diagnosis coding. Let location be your guide to the right ICD-10-CM code for malignant melanoma. You look at the C43 (Malignant melanoma of skin) series for the right code depending upon where the melanoma is located. For example, if your physician documents malignant melanoma of the lip, you submit code C43.0 (Malignant melanoma of lip) and for the nose, you submit code C43.31 (Malignant melanoma of nose).

Similarly, you have discrete codes for eyelids and external auricular canals, both right and left. For the diagnosis of malignant melanoma of eyelids and canthi, you choose from the following:

• C43.1, Malignant melanoma of eyelid, including canthus
• C43.10, Malignant melanoma of unspecified eyelid, including canthus
• C43.11, Malignant melanoma of right eyelid, including canthus
• C43.12, Malignant melanoma of left eyelid, including canthus

For malignant melanoma of the external auricular canals, look at the following codes:

• C43.2, Malignant melanoma of ear and external auricular canal
• C43.20, Malignant melanoma of unspecified ear and external auricular canal
• C43.21, Malignant melanoma of right ear and external auricular canal
• C43.22, Malignant melanoma of left ear and external auricular canal

Other codes for face, scalp, and neck: When your physician does not specify where on the face the tumor was located, you turn to code C43.30 (Malignant melanoma of unspecified part of face). For other unspecified parts of the face, you submit code C43.30. When your physician specifies any other part of the face (for example, cheek), you submit code C43.39 (Malignant melanoma of other parts of face). For scalp and neck, you look at code C43.4 (Malignant melanoma of scalp and neck).

Melanoma on trunk and limbs: For malignant melanoma of the trunk and upper and lower limb, you choose from the following:

• C43.5, Malignant melanoma of trunk
• C43.6, Malignant melanoma of upper limb, including shoulder
• C43.7, Malignant melanoma of lower limb, including hip.

Note: Check for fifth digits that apply to subcategory codes C43.5, C43.6, and C43.7.

Not sure of location? The tumor may involve more than one location. In that case, you have code C43.8 (Malignant melanoma of overlapping sites of skin). When your physician does not specify any location, you submit code C43.9 (Malignant melanoma of skin, unspecified).

Codes for Unclassified Oncology Drugs

The following codes are available for unclassified oncology drugs: 

• J9999, Not otherwise classified, antineoplastic drugs 
• J8999, Prescription drug, oral, chemotherapeutic, NOS
• 3490, Unclassified drugs
• Q0181, Unspecified oral dosage form, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
• J8499, Prescription drug, oral, nonchemotherapeutic, NOS
• J7599, Immunosuppressive drug, not otherwise classified
• C9399, Unclassified drugs or biologicals

Note: When billing a nonclassified medication using a CMS 1500 claim form, you must include both the HCPCS code (e.g., J8999) in the item 24D and the drug name, strength, and National Drug Code (NDC) in item 19 or 24A (shaded area) in order to ensure appropriate reimbursement. However, it is good to check with your payers for any specifications.